Key result
In patients with atrial fibrillation undergoing percutaneous coronary intervention, direct oral anticoagulants did not significantly reduce the primary composite of major and minor bleeding compared to vitamin K antagonists (HR 0.55, P=0.10).
Why the study?
Do direct oral anticoagulants (DOACs) reduce bleeding and thrombotic events compared to vitamin K antagonists (VKA) in patients with atrial fibrillation undergoing percutaneous coronary intervention?
Cohort (n=129)
No
Do direct oral anticoagulants (DOACs) reduce bleeding and thrombotic events compared to vitamin K antagonists (VKA) in patients with atrial fibrillation undergoing percutaneous coronary intervention?
Hazard Ratio: 0.55 (95% CI 0.24–1.11)
Absolute Event Rate: 21.4% vs 38.9%
p-value: p=0.10
In patients with atrial fibrillation undergoing PCI, DOACs are associated with a significantly lower risk of adverse ischemic events compared to VKAs.
BACKGROUND: Whether direct oral anticoagulants (DOACs) are safer and more effective than vitamin K antagonist (VKA) for preventing thrombotic events in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) remains unknown. METHODS AND RESULTS: -VASC and HAS-BLED scores ≥3 was similar between the groups (VKA, 90.5%; DOAC, 84.4%; P=0.31 and VKA, 79.8%; DOAC, 68.9%; P=0.17, respectively). During follow-up (median, 1,080 days), the primary bleeding outcome tended to occur less (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.24-1.11, P=0.10) and the composite secondary efficacy outcome significantly less frequently (HR, 0.40; 95% CI, 0.14-0.91; P=0.03) in the DOAC group. CONCLUSIONS: Compared with DOACs, VKA with poorly controlled INR and antiplatelet agents correlated with adverse outcomes of death, MI, stroke, and TLR in patients undergoing PCI.
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Yoshida et al. (2018) conducted a cohort in Atrial fibrillation undergoing percutaneous coronary intervention (n=129). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonist (VKA) was evaluated on Composite of major and minor bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) criteria (HR 0.55, 95% CI 0.24-1.11, p=0.10). In patients with atrial fibrillation undergoing percutaneous coronary intervention, direct oral anticoagulants did not significantly reduce the primary composite of major and minor bleeding compared to vitamin K antagonists (HR 0.55, P=0.10).
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